Cor Vasa 2017, 59(3):e257-e265 | DOI: 10.1016/j.crvasa.2016.11.004

Cerebral mycotic aneurysm as a consequence of infective endocarditis: A literature review

Shi-Min Yuan^a, Guo-Feng Wang^b,*

^a Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian 351100, Fujian Province, People's Republic of China

^b Department of Neurosurgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian 351100, Fujian Province, People's Republic of China

Background: Cerebral mycotic aneurysm (CMA) secondary to infectice endocarditis (IE) is rare. The clinical features of this entity have not been sufficiently clarified.

Methods: The data source of this study was based on comprehensive literature retrieval of articles published in English 1990-2014 in the PubMed, Highwire Press and Google search engine. The search terms were "infective endocarditis" and "intracranial/cerebral mycotic aneurysm".

Results: The CMAs usually developed 2.1 months after the onset of IE. Staphylococcus was the most frequent pathogen and Streptococcus was more frequent as evidenced by blood culture. The most common presentation on computed tomography was intraparenchymal hemorrhage. Angiogram was a reliable diagnostic means for determining the location of the aneurysm. The middle cerebral artery was the most commonly affected and the posterior cerebral artery was more commonly affected. Interventional or surgical treatments of the CMAs were required in most patients, while some were recovered under conservative treatment. Univariant analysis revealed the development of herniation, parent vessel involvement, aneurysm rupture and non-surgical/interventional treatment of the aneurysms were significant predictive risk factors associated with increased mortality.

Conclusion: The CMAs are risky due to their potential consequences of cerebral hernia and aneurysmal rupture. The treatment of this entity is always challenging as it is difficult to determine the timing of the cerebral and cardiac operations concerning the necessity of heparinization in cardiac surgery.
Sufficient antibiotics have to be used in IE patients in order to prevent from the potential consequence as CMAs. The choices of treatment for CMAs depend on the conditions of CMAs. They are curable to either conservative, endovascular or surgical management in selected patients. At least 2-week interval between clipping or surgical excision of the aneurysm and the cardiac procedure is recommended in patients with a ruptured CMA.

Keywords: Endocarditis; Endovascular procedures; Intracranial aneurysm; Middle cerebral artery

Received: February 21, 2016; Revised: November 3, 2016; Accepted: November 3, 2016; Published: June 1, 2017  Show citation